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ELECTRICAL-INSPECTOR RECORD
<br />APPROVALS ID/SIG.COMMENTS OlVNER BU II,DF,R DEI,('ARATION
<br />I h6cl, ailfln und6 p6.lly ot pqjury tlEt I m erempt am,n the Co mcros Lic.Nc L.w tor lhc aoUowin8 lwn (Se 7011.5
<br />Busin6s a.d Prol6'on Cod.) Any Cny or Counly s,hich ratuirB a p.rnit Io cotrnrucl, ahs. improlr. &noltfi o, repff y
<br />stdcrurc pnor ro ns issrmc., al$ r.qon6 rh. arflicd fo. such p.mir ro fiI. i siln.d $nn.nr rhar hc or slE is licdsd p!6udt
<br />$ rhc pmviliob or dr. Contactoas Licds.d ljrv (Chort6 9, Comm.nci.E \ith Sdrion 7000 of Division I oflhc BuinsltJ
<br />Ptua€sions Cod.) or rhar hc or sh. i! cxemB thd.ftoh dd rhc bdis for rhc all.scd d@prion. A.y violarionoas..lioh 7011.5 by,ny
<br />applicant lor a peflnil subj€clslhc applicanl lo.civilpmaltrofnor mor.lh lire hufldr.d dollms l$500)
<br />l. a ow.c .fr lE pmpcnr. or my cmploy.6 wnh sas6 as rheir elc conp.nsaridn, \ilr do th. *orl dd es!dd.!n r
<br />inlod.d o! oilned ior el. (Sc ?044. B$in6s and ft oa6siorc Cod. Th. C ontacktr s t,i.N tjw do6 .or apply to m oNnd of
<br />thc popany vhobildso!in re!6lhs6n, d who do6 suct \ork himsell o. hmclf or lhrcu-lh his o, ho own mployc6.
<br />plov cdrhatsuch imprormnts dt nor imdded or ofrqld for Flc. Il hor 6d. rhc building or iopmlonol 6 sld s ilhin onc ,w
<br />of compt.lion. rhe Osna Buil&r s ill halc rh. hlrdd ofFovina rha h. or sh. did ml h{ild or i'npmre rhc prepqiy for rhc purpo$ of
<br />L 60*16ofrhcpropeny. M cxclusivcly contraclinS Nirh li.ased co mclo6 ro consrrud th. Foj.cr (Sd 70.14, llNrns
<br />tu Proaaion cod.: Th. ConrE.ld's Liccns.l.av do6 nol an lyto uo(nsofrrop€nr'\ho builds or i'nprovcs lt(on.
<br />and sho conrmds for such p.oj<s silh a ( ontado(, li.m.d prmuaf,r ro rlE( onta.rors Li.m.lav)
<br />I dt exeDpl unds Ssthn
<br />lr.l.: Onner
<br />wdRiEiLaonr PEi{iairiiN'
<br />DECIdAAIIAN
<br />I h6.by afiim u.dcr D..ahy ol p6jury ooc of th€ tollorins d(leatioE
<br />lnavcandNillmaintainaCcnincat€ofConsdlloS.ll-lmu.efor\rorlds comD€.salio..6 pmvid.dforbySdionlT0oofrhc
<br />t bor Codc tor lh. pdiomEcc of lh€ tr o ( aor shich rh. pdnn is isucn
<br />Ihav.andNillnainrainsorkdico'ntbs,lioniNuranc€.6relutcdbyS€crnrnlT00ofrhcl,abo,Code.torrh.pdronnanccoa
<br />rhe {orr for *hich lhis psir is isued M} so*6 compcnsaiion insurancc cmier dd rolicy nnmb6 re:
<br />,,,,,,, . AYWVI LAN O,V
<br />P.n\Ntr.,.' , h,L sD4vo (3 tu+
<br />,^,*",1+++z.o
<br />I ceniirhar innEldfo.n.nc€ofrt.*drk Lr\yhich th6p€rmir is isstrcd.l shillnol d1lloy.nypo$n i.any nroncr
<br />$ N lo bcomc subjsl lo lhc *orks' comp€nsarion l.ws of aallfomia, .nd .rG thal if I shoxld bc.on'. subjrl
<br />'o
<br />th.
<br />$orks co'npcGalion prov*ionsorS<tion lT00 ofrhe l-.bor Codc.lsttrll. ionh*ilh complysith lhos proyisions.
<br />UARNINCT F ilurc ro *cur. *ort.u .o,npLrs.ri.n colerasc is trila*li,l, and shallsuhj.! tu .ntloye kr ni$inalFral(is aid
<br />ciril nn.s up to otr€ hu.dr.d rhousnd doll,rs ($100.m0), in addrion b ihc.os' olcompcisarior. dmag.s a providcd lor lhe
<br />Ihc libo! Code inls6r aod arlo.rey s f.s a ltoY-+za
<br />I ha!b, alnm lidd p€nally of ldjury lhal I an licols.d undd provision ofChaptq I (mmn6cins with S*lion 7000) ollrivision l
<br />of th. Busin6s 3nd PrclsioN Codc. od my licdr$ is in lull for.. dd .f..r
<br />{r Cto ..^.Ntr.,{. q16751?VlLo (,,,,.,.,,,.K VlVlNf gola?
<br />CAISIBIJCIIOTIENDIICAGEICI
<br />I hftby amm nndr Fnal!, of pcjury O,l rh6. is , odrrudirn ldding agdcy lor rh. Ffomdc. olfic vork hr which rhis ,sftn is
<br />ksr.d (sd.1097, civ c )
<br />APPI I(IANT DICLAIIATION
<br />I hglsy affian unds poalr, oaldjury ooc oalh. followi,g d€ldaiionsl
<br />DLnrlition Po,nil3-A.b6ros Notifi .ation Fedo6l Rcsulalions (Tnb 40. Pan6)
<br />Requirel Laln of Norificdio.
<br />I.e1ilyrhdthelcd€.alr€r0lolio.srelddin8$ts'dsr.6ovalturnorrppli.ablcbrhdpmjdr
<br />Llf"o.lry,r,n, rr,n,","",1,r* alplicarion and srarcrhar rhe atFre i.aonnarion is.ortrr. I alre ro comply \irh allciryatul (.unry
<br />or di.n.6 and sr,rc La*( reiar iru h brildi.c conenElion. o l h6eh) {h,rzcrcoGmErr6orrh6( ) MdConnr} ro flr.r upon rhc
<br />r**nxzffi#r-t# *4'tu
<br />Site-Work
<br />Underground
<br />Pole Bases
<br />Light Standards
<br />Spas, Pool, Fountains
<br />Signs (monument)
<br />Life Safety /Low Voltage
<br />Fire Alarm / Dampers
<br />Communications Cable
<br />Building
<br />Under Slab / Floor I
<br />Bonding / Grounding / UFER I t-'6 4,1u/blltfio t-$-67
<br />Transformers )t
<br />Torqueinq
<br />Air Conditioners
<br />Roof Top Equipment
<br />Factory Wired Unit
<br />Walls (Conduit)
<br />Walls (Rough)
<br />Ceilings (Hard & Soffit Rough
<br />Ceilings (T-Bar Rough)
<br />lt/eter Release 2 DAn|q-+E
<br />I
<br />Roug h
<br />Service hrleter
<br />FINAL /')DNIY^'ct-#t')
<br />Notes, Remarks , Etc rt
<br />---t
<br />DATE
<br />Sub-Panels
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